Revolving-door case histories as a special problem in psychiatric care in rural regions - results of an innovative project by Lower Saxony statutory health insurance bodies

Abstract

We report on experiences from a programme of the AOK (Local Statutory Health Care Fund) in Lower Saxony adapted to mental health care reality in rural regions. The purpose of the programme is the prevention of rehospitalisation of chronically mental ill and socially handicapped patients. On the advice of hospital-based psychiatrists a case manager of the AOK immediately organises outpatient interventions for patients after discharge from clinical treatment. Primary goals are to reduce psychosocial deficits and to activate supporting potentials in the social environment of the patients in respect of long-term stabilisation. Outpatient interventions have proved to be an efficient instrument to reduce rehospitalisation rates; they enable patients to experience more quality of life and they are of considerable importance in reducing costs for individual treatments. If we consider the systematics of hospital bed financing, the reduction of individual treatment costs does not imply reduction of AOK total payments for clinical treatment of mentally ill on a short-term basis. Hence, maintenance of this kind of outpatient treatment is strongly recommended.